OBJECTIVE: To present a case of mandibular ameloblastoma with pulmonary metastasis after ten years and discuss the possible pathophysiology, diagnostic and therapeutic options.
METHODS:
 Design: Case Report
 Setting: Tertiary Private Hospital
 Patient: One
RESULTS: A  27-year-old  woman  diagnosed  with  follicular  variant  ameloblastoma  underwent left  segmental  mandibulectomy  with  iliac  bone reconstruction  in  2004.  The  titanium  plates were  removed  in  2008  because  of  a  recurrent  orocutaneous  fistula.  She  was  apparently  well until 2014, when she complained of intermittent, non-radiating, sharp and piercing, right upper back pains. Work-ups revealed multiple bilateral lung nodules.  A CT scan-guided percutaneous needle  biopsy  of  the  right  upper  lung  nodule  revealed  metastatic  ameloblastoma.  Opting  for observation  instead  of  chemoradiation,  she  remains  asymptomatic  on  regular  follow-ups  with medical oncology, pulmonary medicine and otorhinolaryngology.
CONCLUSION: Though  benign,  ameloblastoma  has  a  high  propensity  for  local  invasion  and  may metastasize.  It  is  difficult  to  predict metastasis, even  with  adequate  treatment  of  the  primary lesion. There is no standard protocol to prevent or detect metastatic ameloblastoma, but regular and close follow up may ensure early diagnosis.